Ultrasonic imaging device

ABSTRACT

An ultrasonic imaging configuration rendering an image based on a reflected beam aligned with a needle insertion axis provides enhanced images and guidance. A percutaneous insertion guidance device for ultrasonic (US) imaging includes an US transducer and a reflector for redirecting imaging signals between the transducer and an imaged region. An enclosure or bracket is adapted to support the reflector at a predetermined angle based on a surgical target in the imaged region such that a forward beam direction from the transducer reflects in a direction of the needle insertion as the needle passes through a discontinuity or slot in the reflector. The resulting return signal is based on an axial alignment of the US signals with the needle travel towards the surgical target.

RELATED APPLICATIONS

This patent application is a continuation-in-part (CIP) under 35 U.S.C. § 120 of U.S. patent application Ser. No. 17/083,776, filed Oct. 29, 2020, entitled “RING-ARRAYED ULTRASONIC IMAGING,” which claims the benefit under 35 U.S.C. § 119(e) of U.S. Provisional Patent App. No. 62/927,967, filed Oct. 30, 2019, entitled “RING-ARRAYED ULTRASONIC IMAGING,” and on U.S. Provisional Patent App. No. 63/077,340, filed Sep. 11, 2020, entitled “INSERTION SITE ULTRASONIC IMAGING,” both incorporated herein by reference in entirety.

STATEMENT OF FEDERALLY SPONSORED RESEARCH AND DEVELOPMENT

This invention was made with government support under grant DP5 OD028152, awarded by the National Institute for Health (NIH). The government has certain rights in the invention

BACKGROUND

Medical imaging provides diagnostic views of anatomical structures in a noninvasive manner. Anatomical structures may be identified and assessed prior to any kind of invasive procedure. Such technologies generally involve a propagated wave medium that reflects or refracts off anatomical features for qualitative assessment thereof. Typical imaging technologies include Ultrasound (US), CAT (Computer Assisted Tomography), MRI (Magnetic Resonance Imaging) and X-Ray, each having various features and costs. In particular, ultrasound is beneficial for low cost, portability, and a benign waveform medium that is acceptable in delicate environments such as pregnancy.

SUMMARY

A registration-free ultrasound-guided needle intervention assistance device allowing for viewing of ultrasound images synchronized with the needle insertion motion. A concentric ring array disposes ultrasound (US) transducers in a circular arrangement around an insertion site, while an acoustic mirror reflects US signals to focus the signal for direct alignment with the insertion site and needle path. A Ring-Arrayed Forward-viewing (RAF) ultrasound imaging system includes a ring array of transducers defined by a frame having an open hole or region inside the ring where a percutaneous needle may be inserted.

The use of a circular array provides a forward-viewing US image and needle visualization at the center of the reconstructed image without additional registration. The overall system include a radio frequency (RF) data acquisition receiver for B-mode image reconstruction along the direction of forward needle insertion based on the acquired RF data with a back-propagation method. Acoustically reflective mirrors disposed on or near the insertion site at the center of the array provide additional signal feedback along the needle axis.

Configurations herein are based, in part, on the observation that ultrasound imaging has benefits over other imaging technologies such as CAT (Computer Assisted Tomography), MRI (Magnetic Resonance Imaging) and X-Ray, including cost, size and benign sonic sensing mediums rather than magnetic and radiation mediums which can be harmful to some patients. Unfortunately, conventional approaches to ultrasonic sensing suffer from the shortcoming of imposing manual placement and alignment for invasive procedures such as percutaneous needle insertion for biopsy and other procedures. During such intervention, physicians are required to manipulate the US probe for guiding the direction of needle insertion with their non-dominant hand because the dominant hand guides the biopsy needle, such that the positional relationship between the needle and US images is subject to interpretation by physician's experiences.

Percutaneous needle interventions, such as biopsy or ablation under the guidance of ultrasound imaging, has been a common procedure for diagnosis and treatment of many medical issues. However, conventional ultrasound guided percutaneous needle interventions are highly operator-dependent because of the inherent difficulties in managing hand-eye coordination between the needle and ultrasound transducer to maintain an adequate sonographic window. The ultrasound transducer and needle are two independent entities, and impaired localization and visualization of the needle may result in an increased risk of complications and diminished primary efficacy. Thus, there is an unmet need for an image-guidance device allowing the simple and intuitive needle intervention absent a need for any registration process.

Accordingly, configurations herein substantially overcome the shortcomings of conventional, manual probes by providing guidance device having a circular array of transducers around a needle insertion sleeve centered in the circular array for defining a position and axis of needle travel relative to the transducers. The resulting needle insertion enjoys a fixed registration with the transducers for allowing visualization of a reconstruction plane along the path of needle insertion. The visualized path is rotatable by an encoder or other engagement with the ring array to define both the axial position and relative rotation of a rendered image depicting the insertion path of the needle progressing towards a surgical target.

A system, method and device for generating an image of scanned tissue receives a set of signals from a circular array of transducers, such that the circular array is defined by a circular frame having the transducers disposed thereon. A rotary encoder identifies a reconstruction plane defined by a rotational position of the circular array, and a tracking and imaging circuit generates an image based on the received set of signals by reconstructing, for each of a plurality of positions on the reconstruction plane, a corresponding pixel based on a signal in the set of signals received from each of the transducers on the circular frame.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing and other objects, features and advantages of the invention will be apparent from the following description of particular embodiments of the invention, as illustrated in the accompanying drawings in which like reference characters refer to the same parts throughout the different views. The drawings are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the invention.

FIG. 1 is a system context diagram of a medical diagnosis environment suitable for use with configurations herein;

FIGS. 2A and 2B shows a position of the ultrasound (US) transducers in the environment of FIG. 1 ;

FIG. 3 shows the reconstruction plane for imaging by the transducers of FIGS. 2A and 2B;

FIG. 4 shows an imaging system using the transducers of FIGS. 2A, 2B and 3 in the environment of FIG. 1 ;

FIG. 5 shows example point targets of imaging in the system of FIG. 4 ;

FIG. 6 shows a flowchart for imaging using the system of FIG. 4 ;

FIG. 7 shows an alternate arrangement of the transducers of FIGS. 2A and 2B using concentric rings of transducers;

FIGS. 8A and 8B show an alternate configuration employing an acoustic mirror for enhancing imaging along a needle axis in the system of FIG. 4 ;

FIG. 9 shows manipulation of the acoustic mirror of FIGS. 8A and 8B for generating an image;

FIG. 10 shows a schematic view of a reflector configuration based on the approach of FIGS. 8A and 8B;

FIGS. 11A and 11B show an adjustable reflector in the configuration of FIG. 1 ;

FIG. 12 shows a schematic of the reflector device in conjunction with an imaging probe;

FIG. 13 shows a rear perspective view of a probe as in FIG. 12 engaged with the reflector device;

FIG. 14 shows a front perspective view of the device of FIG. 13 ; and

FIGS. 15A-15D show alternate configurations of the device of FIGS. 13 and 14 with a needle insertion body.

DETAILED DESCRIPTION

The description below presents an example of the RAF device for reconstructing image data defining a plane along an insertion path of a surgical needle, typically a transcutaneous needle in conjunction with an epidermally placed RAF device. FIG. 1 is a system context diagram of a medical diagnosis environment 100 suitable for use with configurations herein. Referring to FIG. 1 , an operator 101 such as a doctor, nurse or medical technician operates a needle 110 for insertion. The RAF device for needle insertion (device) 120 rests on an epidermal surface 112 of a patient 114. A rotatable, circular frame 150 rotates for gathering ultrasonic signals depicting a reconstructed plane image 132 including a surgical target 134, for processing and rendering the signals and rendering an image 140 on a monitoring device 142 for visual feedback of needle 110 insertion and aiming towards the surgical target 134. The frame 150 surrounds a sheath 130 centered in the frame 150 for guiding the needle 110 to the surgical target 134.

The monitoring device 142 allows rendering of the image 140 of the surgical target 134, such that the surgical target 134 is located on the reconstruction plane 132 and based on an insertion site aligned with a needle on a trajectory defined by the needle insertion sheath 130. Since the needle path is centered among the transducers, the reconstructed plane image 132 includes the path at any rotation of the reconstructed plane image 132. The surgical target 134 may be, for example, a region or growth for retrieving a biopsy sample, or the reconstructed plane 132 may simply define a diagnostic region for further imaging.

FIGS. 2A and 2B shows a position of the ultrasound (US) transducers in the environment of FIG. 1 . Referring to FIGS. 1 and 2 , the device 120 includes a circular frame 150 of US transducers (transducers) 152-1 . . . 152-8 (152 generally). Any suitable number of transducers may be employed; 8 are shown for ease of illustration, however an actual RAF array may have around 300 elements, and impose merely that an encoder having sufficient resolution is employed.

The array 160 is employed for a method for generating an image of scanned tissue, which includes receiving a set of signals from a circular array 160 of transducers 152, in which the circular array 160 is defined by the circular frame 150 having the transducers 152 disposed thereon. Based on positional input from an encoder (discussed below), the reconstruction plane 132 is identified, defined by a rotational position of the circular array 160. As shown in FIG. 5B, individual transducers 152-1, 152-8, and 152-5 emit sonic pulses 252-1, 252-8 and 252-5, respectively. The image 140 is generated based on a received set of signals shown by arrows 252′-1 . . . 252′-8 and 252′-5 (252′ generally), by reconstructing, for each of a plurality of positions on the reconstruction plane 132, a corresponding pixel based on a signal in the set of signals 252′ received from each of the transducers 152.

Identification of the reconstruction plane 132 includes aligning the reconstruction plane with a center 164 of the circular array based on the needle positioning sheath 130 adapted to slidably receive a needle 110 for directing the needle to the target location 134 depicted on the generated image 140. This ensures that the target location and the needle 110 are aligned with the reconstruction plane 132 and visualized on the generated image 140.

FIG. 3 shows the reconstruction plane 132 for imaging by the transducers of FIGS. 2A and 2B. Referring to FIGS. 1-3 , the relation of the circular transducer array 160 to the reconstruction plane 132 is shown in the imaging system 102 which tracks insertion of the needle 110 into the center 164 of the transducers 152. to visualize forward-views corresponding to the articulated needle posture by measuring a rotational position 166 based on movement of the frame 150 around the insertion site. Computations based on a coordinate plane 168 and angular values defined by the rotational position compute the rendered image 140 and any surgical targets 134 therein based on the reconstruction plane 132. Horizontal rotation 166′ may also be achieved by slightly tilting the sheath 130, discussed further below.

In generating the reconstruction plane and tendering the image 140, transducer signals 252 are emitted and ultrasonic signals returned 252′ from the tissue located in the reconstruction plane 132. Generally, the return signals 252 indicate a relative density of tissue which can be depicted in the rendered image 140 as varied shades. Unlike a conventional linear transducer array in a typical hand-held probe, the signals emit and return to the transducers 152 in a circular pattern, which thus varies based on an angle on the frame 150 from which the signals are received.

The return signal from an individual transducer defines a so-called A-mode, or A-line data. A-mode return signals 252′ result in a waveform with spikes or peaks at the interface of two different tissues, for example where subcutaneous fat and muscle meet. B-mode scans produce a two-dimensional image of the underlying tissue, while A-. The A-mode (amplitude mode) is the simplest type of ultrasound. In A-Mode, A single transducer scans a line through the body with the echoes resulting as a function of depth. A B-mode, sometimes referred to as 2D or (brightness mode) a linear array of transducers simultaneously scans a plane through the body that can be viewed as a two-dimensional image on screen.

To visualize the forward-viewing rendered image 140 based on the tracked needle posture, a beamforming technique is employed to reconstruct the US image with RF A-line data acquired by the ring-arrayed single element transducers 152. Synthetic aperture imaging and plane wave imaging are conventional reconstruction methods which can provide sequential US image data one line at a time. For example, both monostatic synthetic aperture and plane wave imaging may be employed to perform simple data acquisition by invoking the same transducer 152 element as a transmitter and a receiver, which can provide effective dynamic range and resolution of the image. Configurations herein extend monostatic synthetic aperture imaging to enable visualization of the forward-viewing rendered image 140 based on the ring-arrayed single element transducers 152.

US signals are transmitted and reflected wave-fronts, defining the A-line RF data, and are received at each transducer 152-N position, thereby an x-z plane B-mode image is formed line by line. Meanwhile, in the ring-array 150, the positional relationship between the reconstructed plane 132 and each transducer 152 position receiving RF A-line data is different from a conventional linear array because of the circular arrangement. Thus, the ring-arrayed positions of the single element transducer 152 can be defined as:

$\begin{matrix} {e_{i} = {\left( {{r{\cos\left( t_{i} \right)}},{r{\sin\left( t_{i} \right)}},0} \right)\left\lbrack {0 \leq t_{i} \leq {2\pi}} \right\rbrack}} & (1) \end{matrix}$ $t_{i} = {\frac{2\pi}{L}{i\left\lbrack {0 \leq i \leq L} \right\rbrack}}$

Where ei represents the position of i-th transducer in the number of L single element transducers. Also, r represents the radius of the circular array, i.e. frame 150.

In order to incorporate the RF A-line data corrected by the ring-arrayed single element transducers real-time, a back-propagation approach is applied, depicted further in FIG. 5 below. This approach can project the collected A-line data back to the predefined 2D field used for visualizing the targeted slice. The reconstruction with the back-propagation can be formulated as follows:

$\begin{matrix} {{y_{bf}\left( {m,n} \right)} = {\sum\limits_{e}{y_{bfe}\left( {m,n,e} \right)}}} & (2) \end{matrix}$ $\begin{matrix} {{y_{bfe}\left( {m,n,e} \right)} = {y_{pre}\left( {d,e} \right)}} & (3) \end{matrix}$

Where ybf is the total reconstructed RF data, ybfe is the reconstructed RF data from each transducer position, and ypre is the received raw RF data. m and n depict the pixel information of the lateral and axial direction in the reconstruction image, respectively. The distance used when collecting the pre-beamformed data is d, and the transducer position is e. The received signal distance can be calculated with the Euclidean distance between the pixel position of the reconstruction image and transducer position, following:

d=∥p _(m,n) −e∥  (4)

p_(m,n) represents the pixel position of m-by-n matrix in the 3D world coordinate system, which is dependent on the slice angle of reconstruction image in the radial direction. Further, to decrease the effect of side lobes, a coherent factor used as a metric of focusing quality is applied. It is defined as the ratio between the coherent and incoherent sums across the array. The coherent factor performs such that high and low values indicate high- and low-quality image, respectively. By applying the coherent factor to the back-propagation approach, Eq. (2) can be replaced, as follows:

$\begin{matrix} {{y_{{bf}_{CF}}\left( {m,n} \right)} = {{{CF}\left( {m,n} \right)}{\sum\limits_{e}{y_{bfe}\left( {m,n,e} \right)}}}} & (5) \end{matrix}$ $\begin{matrix} {{{CF}\left( {m,n} \right)} = \frac{{❘{\sum_{e}{y_{bfe}\left( {m,n,e} \right)}}❘}^{2}}{L{\sum_{e}{❘{y_{bfe}\left( {m,n,e} \right)}❘}^{2}}}} & (6) \end{matrix}$

FIG. 4 shows an imaging system using the transducers of FIGS. 2A, 2B and 3 in the environment of FIG. 1 . Referring to FIGS. 1-4 , the Ring-Arrayed Forward-viewing (RAF) ultrasound imaging and administration device 102 is shown in further detail. The device 102 includes an ultrasonic (US) US imager 104 including a plurality of single element transducers 152 arranged in the circular frame 150 to define the ring array 160, and an ultrasound imaging and tracking circuit 170 coupled to each transducer 152 in the ring array 160 for performing RF (radio frequency) data acquisition with the plurality of ring-arrayed transducers 152. Imaging logic 172 includes a set of processor based instructions for performing the imaging as described above for rendering the image 140 based on the signals 252.

A needle holster 130 is concentrically disposed in the ring array 160 and is adapted to receive and direct an insertion instrument such as needle 110 along an axis 111 defined by a center 164 of the ring array 160 and aligned or nearly aligned with the surgical target 134. A rotary encoder 174 is responsive to rotation of the ring 150 for providing the rotational position to the tracking circuit 170. Any suitable mechanism for identifying and reporting the rotation may be provided.

In the configuration as shown, the circular array 150 has a center axis 111 defining a radius 180 to each of the transducers 152. The plurality of transducers 152 is disposed in the circular frame 150 to define the circular array 160, such that the transducers 152 are centered around the needle insertion sheath 130 defining the needle axis 111. The tracking circuit 170 computes each pixel on the rendered image 140 from a value based on a distance 136 from the location on the reconstruction plane 132 to each respective transducer 152, such that the distance is computed based on the radius. Each location corresponding to a pixel also has an angle 137 from the transducer 152 and a depth 138, which is a function of the angle 137 and distance 136, which define a location on the reconstruction plane 132. In the circular array 160, the radius will be the same to each transducer, however in alternate configurations, the circular frame 150 may take an elliptical or oval form, in which it further comprises a major axis and a minor axis. Elliptical considerations may also occur based on a tilting of the sheath 130 that draw the array 150 off of a true perpendicular or normal path to the target 134.

FIG. 5 shows example point targets of imaging in the system of FIG. 4 . Referring to FIGS. 3-5 , the transducer 152 locations 160′ of the circular array 160 are shown aligned with the uppermost boundary of the reconstruction plane 132, defining 0 degrees of rotation. Sensing locations are shown as a downward spiral 161 of imaged locations, having increasing depth based on a range 165 of target depth. The tracking circuit 170 receives a rotation signal, such that the rotation signal is based on the encoder 174 in rotary communication with the circular frame 150. Depending on the rotation, the tracking circuit 170 may identify a second reconstruction plane based on the rotation signal, as the relative transducer position to the reconstruction plane 132 moves one or more transducer positions 160′. The tracking circuit 170 then renders an image 140 based on the second reconstruction plane, representing a shift of one or more transducer positions 160.′

FIG. 6 shows a flowchart for imaging using the system of FIG. 4 . Referring to FIGS. 1-6 , a flowchart 600 depicts a sequence for generating the image 140. At step 601, the imaging device 104 is disposed on the patient 114 at a location deemed above the target location 134 for mounting device 104. After mounting the device 104, RF data is collected continuously from the ring-arrayed transducers 152, shown at step 602 while the needle posture is set by rotating the device 104, as depicted at step 603. The forward-viewing US images 140 are reconstructed and rendered based on the needle posture, as disclosed at step 604, based on emission of an ultrasonic (US) beam from each of the transducers 152 around the circular array 160. The rendered image 140 may be employed to evaluate an acceptable insertion path directly by changing the (rotation) needle posture or shifting the device on the body surface 112 in a slidable manner, depicted at step 605 and performed iteratively until an acceptable path axis 111 is found. Once an acceptable needle 110 insertion path is found, the needle angle will be fixed and insertion commenced, as shown at step 606. The rendered forward-viewing image 140 continually updates in real-time during the needle insertion for tracking the needle location 607 as the needle advances towards the target 134 along the axis 111, depicted at step 608. The tracking circuit 170 continues to render the generated image along a forward direction of needle insertion, until the target is attained at step 609.

In operation, as the device 304 is positioned and the needle 110 advanced, the transducers 152 emit and receiving a return signal at each emitting transducer or a combination of multiple transducers in proximity to the emitting transducer. Each transducer is a single element transducer operable for transmission and reception of US signals. The tracking circuit 170 computes, based on each of a plurality of positions on the reconstruction plane 132, a value for the corresponding pixel based on the return signal from a plurality of the transducers 152. In other words, the transducers emit 252 and receive signals 252′ in an iterative manner for the depth and width of the reconstruction plane 132. For each scanned or imaged position on the reconstruction plane, the tracking circuit receives and evaluates a return signal 252′ to compute a value of a corresponding pixel in the rendered image 140, as disclosed above with respect to FIG. 4 . The tracking circuit 170 iterates over a plurality of positions on the reconstruction plane 132 for computing a value for a corresponding pixel of each pixel of the generated image 140. Each transducer 152 receives the return signal 252′ based on a depth, distance and angle to the corresponding location on the reconstruction plane 132 from the respective transducer 152.

FIG. 7 shows an alternate arrangement of the transducers of FIGS. 2A and 2B using concentric rings of transducers. Referring to FIGS. 1-7 , the circular frame 150 may have multiple concentric arrays 160-1 . . . 160-N of transducers 152. Each of the transducers 152 defines a radius based on a distance to the center of the circular frame, such that all transducers of a first ring have an equal radius, and all transducers of an outer ring have an equal but greater radius than the first or innermost ring.

The frame 150 disposes the transducers 152 according to a plurality of radii 180-1 . . . 180-2 (180 generally) around the circular frame 150, and generates the image 140 from a distance to each of the plurality of positions on the reconstruction plane 132, and an angle 137 defined from the circular frame to the respective position. Each of the concentric rings therefore defines a layer 181-1 . . . 181-3 (181 generally) according to the incremental radii. In the multi-ring approach of FIG. 7 , design parameters of the ring array configuration are mainly considerable as following: 1) the hole radius R_(h), 2) the outer radius of whole ring array R_(o), 3) the total number of transducer elements E, 4) the number of ring layer N_(e), and 5) the number of transducer element in each ring layer M_(e) as shown in FIG. 7 . Given that the transducer elements 152 are equally spaced in the array 150 plane, the position of each transducer element e can be defined in a polar coordinate system as following:

e(r,θ)=(R _(h) +n _(e) d _(r) ,m _(e) d _(θ))

n _(e)=1 . . . N _(e)

m _(e)=1 . . . M _(e)

E=N _(e) M _(e)

where d_(r) and d_(θ) represent the pitch distance of each transducer element along the radical direction and the pitch angle of each transducer in each ring layer, and n_(e) and m_(e) represent the layer number and transducer element number in the ring layer. d_(r) and d_(θ) are also determined as following:

$d_{r} = \frac{R_{o} - R_{h}}{N_{e}}$ $d_{\theta} = \frac{2\pi}{M_{e}}$

The conceptual result is merely that the central void or “hole” at which the needle axis 111 is centered varies in size.

FIGS. 8A and 8B show an alternate configuration employing an acoustic mirror for similar operation in conjunction with the ring array, and further enhancing imaging along a needle axis in the system of FIG. 4 . Referring to FIGS. 4, 8A and 8B, an indirect transducer 852 is attached to a crossmember 800 extending across the frame 150. The reflective surface of the mirror 854 and transducer can rotate and translate to capture 3D volume and provide equivalent information, possibly in conjunction with the array 160. An acoustic mirror 854 is disposed at an angle (typically 45°) adjacent the needle sheath 130. The acoustic mirror 854 is disposed at a center of the circular frame 150, such that the reflective mirror has a surface responsive to the signals for reflecting the signals onto the reconstruction plane 132 based on an angle of the mirror. The mirror 854 has an aperture or hole 855 for allowing passage of the needle 110, such that the hole is sufficiently small that it will not interfere substantially with the emitted and return signal, but allows redirection of the signals aligned or substantially aligned with the needle axis 111. The needle 110 is thus received through the aperture 855 in the mirror; and the tracking circuit 170 generates the image 170 based on coalescing the reflected signals with the received set of signals. The transducer 852 is disposed in proximity to the mirror 854, either on the crossmember 800 or coupled via an optical fiber, and transmits a signal horizontally at the 45° mirror for achieving a 90° reflection parallel to the reconstruction plane 132.

FIG. 8B illustrates reflection of the signal emitted from the transducer 852 as beam 860 and directed towards the servo-operated mirror 854, Depending on activation of the servo motor, the mirror 854 is rotatable to a variety of positions such as 854′ and 854″ for reflecting the beam 860 to different tissue regions. In particular configurations, the transducer 852 may also be translated and rotated by actuators, such as for generating a corn beam. Alternate surgical targets 134-0 . . . 134-2 beneath the epidermal surface 112 can be imaged by the beam 869 based on the position of the mirror 854 in response to rotation by the servo motor. A single dimension is shown, but rotation in two dimensions may be achieved by disposing the mirror 854 in a frame or assembly such as a gimbal.

In FIG. 8B, rotation of the mirror to an angle defined by 854′ reflects the beam 860′ to surgical target 134-1. Similarly, a tighter (more acute) angle is achieved by an angle defined by 854″, reflecting the beam 860″ towards surgical target 134-2. Larger scan areas may be covered with fewer transducers by having the beam 860 image regions in succession such as 134-0, 134-1 and 134-2.

Further enhancements can be achieved by motorizing translation and rotation of the transducer 852 and bending the ultrasound beam to cover the intended reconstruction area utilizing an acoustic mirror 854 as a reflector. The reflector is positioned in front of the array with an angle to reflect the forward-shot US beam. Hence, given that the relative angle between the 1D array and reflector is set at 45°, the forward-shot US beam can be reflected 90°. This approach provides a variable angled B-mode slice based on the adjustment of the relative angle and position between the array and reflector, and the volumetric image can be formed as a composition of serial B-mode slice consecutively acquired through the translational and rotational motions of the 1D array and reflectors. High resolution 3D imaging can be achieved in this configuration by incorporating out-of-plane synthetic aperture beamforming.

FIG. 9 shows manipulation of the acoustic mirror of FIGS. 8A and 8B for generating an image. The mirror 854 enhances visualization of the forward-view of needle insertion by utilizing a 1D linear array transducer 852′ to emit and receive the US beam and an acoustic reflector 854. In the example shown, the transducer 852′ may be a single element, as in 152 above, or an array. The emitted beam is reflected first by preliminary mirror 854′ along a horizontal path normal to the needle axis 111, then reflected again at the needle 110 by the mirror 854 along the needle axis 111, such that the needle 110 passes through the aperture 855 and onward to the surgical target 134. Actuated movement and angling (rotation) of the mirrors allow imaging of larger regions as the transducer beam is redirected over the imaged area.

The disclosed approach performs imaging of a rotatable plane including a needle insertion path based on a reconstruction from sensor readings around the circular array. In alternate configurations, an image based on a reflected beam aligned with the needle insertion axis provides enhanced images and guidance. A percutaneous insertion guidance device for ultrasonic (US) imaging includes an US transducer and a reflector for redirecting imaging signals between the transducer and an imaged region. An enclosure or bracket is adapted to support the reflector at a predetermined angle based on a surgical target in the imaged region, such that a forward beam direction from the transducer reflects in a direction of the needle insertion as the needle passes through a discontinuity, such as a notch or slot in the reflector. The discontinuity is formed in the reflector, and is sized for receiving a needle directed towards a surgical target in the surgical region, having minimal effect on the reflective capability of the US sensing beam. The resulting return signal is based on an axial alignment of the US signals with the needle travel to a surgical target.

FIG. 10 shows a schematic view of a reflector configuration based on the approach of FIGS. 8A and 8B. Referring to FIGS. 8A, 8B and 10 , a disposable reflector add-on attaches to commercially available ultrasound probes for easier needle targeting. For an example configuration, ultrasound guided access for percutaneous nephrolithotomy (PCNL) is gaining popularity amongst urologists, and the disclosed approach improves steep learning curve associated with this procedure via registration-free needle 110 insertion. An add-on form factor integrates easily with existing imaging hardware, avoiding the need for replacement of existing imaging probes. In a basic form, the approach includes a reflector 154 for redirecting imaging signals between a transducer 152 and an imaged region, and an enclosure adapted to support the reflector 154 at a predetermined angle 115 based on a surgical target in the imaged region, and a receptacle adapted to engage an imager including the transducer, such that the receptacle orients the imager with a forward beam direction aligned with the reflector 154. The receptacle is based on a shape of the imager or probe for aligning the forward beam direction towards the reflector. The angle 115, typically at or near perpendicular, redirects the forward beam into alignment with a needle 110 or similar surgical probe directed to the surgical target.

Needle insertion under the guidance of ultrasound (US) imaging has been a common procedure as an alternative to fluoroscopy guidance for percutaneous nephrolithotomy (PCNL) access. To perform the ultrasound (US) guided-needle insertion, physicians simultaneously manipulate the needle and US probe with each of their hands, and are required to manage hand-eye coordination between the needle and a rendered US image tracking surgical progress. Meanwhile, needle movement is challenged due to the difficulty of registration of hand-eye coordination. It often requires reinsertions when the needle trajectory deviates from the rendered image, which increases the operation time and burden and may cause complications such as severe hemorrhaging. While conventional navigation systems have been proposed to guide the procedure, most require additional tracking devices for image-to-tool registration, which complicates the procedure and often increase the cost. Thus, there is an unmet need for an image-guidance device allowing simple and intuitive needle intervention without requiring a registration process. Configurations below provide a registration-free US-guided needle intervention assistance device allowing for viewing US images aligned with the needle insertion direction.

The circular array above reconciles radial and angular positions of the circularly located transducers around the needle insertion path. The reflector approach below aligns the transducer signal directly with the insertion axis of the needle to avoid the need for angular or side emanating signals. The forward beam path follows a trajectory based on a single angular reflection as the transducer beam meets the needle insertion axis, typically at or near 45° from a transducer or probe disposed on an epidermal surface perpendicular to the insertion axis.

Acoustic reflectors are able to reorient acoustic waves with minimal energy loss. Previous developments have demonstrated successful acoustic reflector application in 3-D US imaging. Acoustic reflectors are usually made of materials, such as glass and metal, whose acoustic impedance is significantly different from that of medium of acoustic wave propagation, such as water and gel; thus, there is a high acoustic reflection coefficient on the media interface. The reflection of acoustic waves in the proposed imaging mechanism is illustrated in FIG. 10 , below. The acoustic incidence angle θ_(i) is related to the refraction angle θ_(r), described as:

$\frac{\sin\left( \theta_{i} \right)}{\sin\left( \theta_{r} \right)} = {\frac{c_{1}}{c_{2}}.}$

The acoustic wave propagates from Medium 1 (speed of sound is c₁) into Medium 2 (speed of sound is c₂). Although only longitudinal wave approaches the media interface, there can be both longitudinal and shear waves transmitting into Medium 2. Speeds of longitudinal and shear waves in Medium 2 are denoted as c_(2d) and c_(2s), respectively. A significant condition occurs when the refraction angle of the longitudinal wave becomes 90°, and the corresponding incident angle is defined as the first critical angle θ_(c1), as below. If θ_(i)>θ_(c1), no longitudinal wave transmits through the interface:

$\theta_{c1} = {a{\sin\left( \frac{c_{1}}{c_{2d}} \right)}}$

A second significant condition occurs when the refraction angle of shear wave becomes 90°, and the corresponding angle is defined as the second critical angle θ_(c2).

$\theta_{c2} = {a{\sin\left( \frac{c_{1}}{c_{2s}} \right)}}$

If θ_(i)>θ_(c2), all acoustic energy that arrives on the media interface will be reflected. In configurations herein, the acoustic reflector may be made of glass and immersed in water or gel. Given these conditions, c₁, c_(2d), and c_(2s) are assumed to be 1480, 5100, and 2840 m/s, respectively. It could be easily computed using the above equations that θ_(c1)˜=16.87° and θ_(c2)˜=31.41°. Since the incident angle is 45° in the proposed imaging mechanism (larger than both critical angles), there will be no loss in acoustic energy in acoustic reflection.

FIGS. 11A and 11B show an adjustable reflector in the configuration of FIG. 10 . Referring to FIGS. 10-11B, the reflector 154 engages a positioning member adjustable for directing the signals towards a surgical target based on the angle 115-1, 115-2 (115 generally) of the acoustic reflector 154. This may include a rotary adjustment for changing the predetermined angle based on an imaged location of the surgical target. The approach aims to visualize the forward-view of needle insertion by utilizing a 1D linear array transducer to emit and receive the US beam, and an acoustic reflector with a discontinuity such as a slot or hole which allows the needle to pass through. The reflector 154, such as a mirror, can reflect the US beam 122 and bend it along an arbitrary direction by adjusting the relative angle between the US beam and reflector. Thus, such a configuration enables alignment of the direction of needle insertion and US beam path by synchronizing the needle posture information with the reflector angle information. This provides an arbitrary angled B-mode image matching to the intended needle insertion path, which depicts the needle trajectory at the center of the image.

FIG. 12 shows a schematic of the reflector device in conjunction with an imaging probe 155. Referring to FIGS. 10-12 , the system is composed of an ultrasound transducer 152, at a forward end of the probe, employing only a single acoustic reflector 154. The acoustic reflector 154 is placed in front of the ultrasound transducer to redirect or “tilt” the ultrasound beam 122. The reflector has an open space, such as a slot, hole or other discontinuity 124 in the middle of the reflector so that the needle path can be overlaid with the image plane without requiring registration. An acoustic-coupling medium 128 (such as water, old, or gel) fills the space 126 between the ultrasound transducer 152 and acoustic reflector 154 to create the acoustic coupling. The encapsulation is designed to allow the needle to pass through the proposed system without causing acoustic-coupling medium leakage. Two variations of the proposed system are disclosed; in FIG. 10 , the acoustic reflector is installed at a fixed angle (set at 45-degree with respect to the ultrasound probe), and the needle 110 can be inserted vertically. In the configuration of FIGS. 11A and 11B, the needle 110 and the reflector 154 are both rotatable, and their motions are synchronized. The needle 110 rotation amount is two times the amount of rotation on the reflector 154 to ensure the image-needle alignment. This disclosure particularly elaborates on the concept adaptation for urology applications such as PCNL access.

FIG. 13 shows a rear perspective view of a probe as in FIG. 12 engaged with the reflector device. The device 105 defines a receptacle 152 adapted to engage the probe 155 or imager including the transducer 152, where the receptacle 152 orients the imager with a forward beam direction aligned with the reflector 154. In the form factor of FIGS. 13 and 14 , the enclosure includes a base 145 having the void or receptacle 152 adapted for receiving an US transducer 152 and accompanying probe 155 in a parallel orientation with an epidermal surface for insertion. A complementary cover 145′ further secures the probe 155 and defines the encapsulated space 126 for the acoustic gel 128. The acoustic reflector 154 occupies a positioning member in the enclosure and is disposed for redirecting signals between the US transducer 152 and a surgical region, where the surgical region is defined by a region appurtenant with and below the epidermal surface. A positioning member (discussed below) supports the acoustic reflector in the path of a forward beam direction from the US transducer and oriented at an angle for redirecting signals from the forward beam direction towards the surgical region. A discontinuity 124 formed as a notch receives the needle 110 directed towards the surgical region for alignment with the angle of the acoustic reflector.

FIG. 14 shows a front perspective view of the device of FIG. 13 . The front view depicts the discontinuity 124, shown as a slot or notch in the reflector 154 to allow the needle 110 access. Since there is an encapsulated space 126 between the transducer 152 and the acoustic reflector 154, the encapsulation is designed to enclose the insertion guidance device so that the open space between the acoustic reflector and the ultrasound transducer can be filled with the acoustic-coupling medium 128 (such as water, oil or gel). The medium 128 allows the acoustic wave to be transmitted from the transducer, be reflected by the acoustic reflector, and then be delivered to the patient's body. The acoustic wave travels the same path to be received by the ultrasound transducer. A bottom layer (made with acoustically transparent materials) is used to enclose the device. The discontinuity 124 is designed in the middle of the encapsulation to allow the needle to pass freely, preventing the needle from piercing through the bottom layer and causing leakage of acoustic-coupling medium. In addition, with such a notch, quick release of the needle is possible following insertion. A quick needle-releasing mechanism can be installed to hold and detach the needle from the encapsulation attachment.

Usage in a PCNL procedure may include a set of ordered steps for performing the ultrasound-guided access:

1. Prepare the guidance device by attaching the reflector-integrated attachment to the ultrasound probe

2. Fill the encapsulated attachment with the acoustic-coupling medium.

3. Place the device on the epidermal surface of the patient's back to image the kidney.

4. Observe the real-time ultrasound image and find the best position and orientation for needle insertion. The needle can be inserted at the center of the ultrasound image.

5. Insert the needle with image guidance until the needle tip reaches the targeted region in the kidney.

6. Release the needle from the device through the notch. The inserted needle is used to insert guide wire and other tools to proceed with PCNL procedures.

The need for simpler and more intuitive US guidance for needle insertion is not restricted to PCNL and can apply to a variety of clinical applications. The device 105 comes in the shape of an attachment that can be secured onto the probe of choice.

FIGS. 15A-15D show alternate configurations of the device of FIGS. 13 and 14 with a needle insertion body for assisting needle guidance and adjusting the needle 110 and reflector 154. FIGS. 15A-15B show front and rear perspective views of a needle insertion body 200 in a fixed, 90° orientation. FIGS. 15C-15D show an adjustable needle insertion body 300 for adjusting the angle 115 of the reflector to correspond to the needle 110. Referring to FIGS. 10, 15A and 15D, the angle 115 directing the signals towards the surgical target are based on an intersecting path of the needle 122 with the surgical target. The needle insertion body 200, 300 includes a needle insertion slot 125 for directing the angle corresponding to the reflector 154. In FIGS. 15A-15B, the needle insertion slot is at 90° to the probe 155 forward beam, resting on the epidermal surface, and the reflector is at 45°. In FIGS. 15C and 15D, the needle insertion slot 125 is at 2× the reflector angle, adjusted by a geared 113 or other positioning member, thus aligning the reflector 154 to direct the beam 122 with the needle 110.

In the example configurations, the discontinuity 124 is an aperture in the reflector 154, such that the aperture is sized for receiving a needle 110 directed towards a surgical target in the surgical region. Regardless of the shape, the discontinuity 124 is for receiving an elongated surgical instrument such as a needle 110 through a plane defined by the reflector 154. The configurations of FIGS. 15A-15D depict a receptacle contoured for receiving and orienting an imaging probe including at least one transducer, such that the transducer 152 configured for emitting an imaging signal and receiving a return signal from the surgical region. An array of transducers may also be employed.

Those skilled in the art should readily appreciate that the programs and methods defined herein are deliverable to a user processing and rendering device in many forms, including but not limited to a) information permanently stored on non-writeable storage media such as ROM devices, b) information alterably stored on writeable non-transitory storage media such as solid state drives (SSDs) and media, flash drives, floppy disks, magnetic tapes, CDs, RAM devices, and other magnetic and optical media, or c) information conveyed to a computer through communication media, as in an electronic network such as the Internet or telephone modem lines. The operations and methods may be implemented in a software executable object or as a set of encoded instructions for execution by a processor responsive to the instructions, including virtual machines and hypervisor controlled execution environments. Alternatively, the operations and methods disclosed herein may be embodied in whole or in part using hardware components, such as Application Specific Integrated Circuits (ASICs), Field Programmable Gate Arrays (FPGAs), state machines, controllers or other hardware components or devices, or a combination of hardware, software, and firmware components.

While the system and methods defined herein have been particularly shown and described with references to embodiments thereof, it will be understood by those skilled in the art that various changes in form and details may be made therein without departing from the scope of the invention encompassed by the appended claims. 

What is claimed is:
 1. An imaging device, comprising: a reflector for redirecting imaging signals between a transducer and an imaged region; an enclosure adapted to support the reflector at a predetermined angle based on a surgical target in the imaged region; and a receptacle adapted to engage an imager including the transducer, the receptacle orienting the imager with a forward beam direction aligned with the reflector.
 2. The device of claim 1 wherein the receptacle further comprises a void for receiving and orienting an imaging probe including at least one transducer, the transducer configured for emitting an imaging signal and receiving a return signal from the surgical region.
 3. The device of claim 1 wherein the reflector further comprises a discontinuity for receiving an elongated surgical instrument through a plane defined by the reflector.
 4. The device of claim 3 wherein the discontinuity is an aperture in the reflector, the aperture sized for receiving a needle directed towards a surgical target in the surgical region
 5. The device of claim 3 wherein the discontinuity is a slot in the reflector, the slot sized for receiving a needle directed towards a surgical target in the surgical region
 6. The device of claim 1 wherein the reflector is an acoustic reflector, further comprising a receptacle based on a shape of the imager for aligning the forward beam direction towards the reflector.
 7. The device of claim 1 further comprising a rotary adjustment, the enclosure responsive to the rotary adjustment for changing the predetermined angle based on an imaged location of the surgical target.
 8. The device of claim 7 wherein the imaged region is a surgical region including a kidney.
 9. The device of claim 3 wherein the enclosure defines a dermal surface adjacent the imaged region and the surgical instrument is a needle extending perpendicular to the dermal surface.
 10. The device of claim 3 wherein the discontinuity further comprises a slot, the slot defining a needle alignment for the elongated surgical instrument, the needle alignment varying by a factor of 2 with the predetermined angle.
 11. A percutaneous insertion guidance device for ultrasonic (US) imaging, comprising: an enclosure having a void adapted for receiving an US transducer in a parallel orientation with an epidermal surface for insertion; an acoustic reflector in the enclosure and disposed for redirecting signals between the US transducer and a surgical region, the surgical region defined by a region appurtenant with and below the epidermal surface; a positioning member supporting the acoustic reflector aligned with a forward beam direction from the US transducer and oriented at an angle for redirecting signals from the forward beam direction towards the surgical region; and a notch for receiving a needle directed towards the surgical region and aligning the needle with the angle of the acoustic reflector.
 12. The device of claim 11 wherein the surgical region includes a surgical target, the angle directing the signals towards the surgical target based on an intersecting path of the needle with the surgical target.
 13. The device of claim 11 wherein the positioning member is adjustable for directing the signals towards a surgical target based on the angle of the acoustic reflector.
 14. The device of claim 11 wherein the notch has a size based on a diameter of the needle for receiving the needle, and the acoustic reflector is disposed at an angle aligning the redirected signals with an insertion axis of the needle.
 15. The device of claim 11 wherein the acoustic reflector is aligned for bidirectional communication of signals emanating from the US transducer in the forward direction and return signals reflected from the surgical region.
 16. The device of claim 11 further comprising a void in the enclosure between the US transducer and the acoustic reflector, the void adapted for containing an acoustically transmissive substance for signal transport between the acoustic reflector and the US transducer.
 17. The device of claim 16 wherein the enclosure receives the US transducer in a position aligning the forward beam direction with the notch and the acoustic reflector based on a needle insertion path passing through the notch substantially perpendicular to the forward beam direction.
 18. The device of claim 6 wherein the angle varies a direction of the reflected signals along a plane including the forward beam direction and an insertion path of the needle,
 19. The device of claim 11 wherein the positioning member includes a shelf on an interior of the enclosure for slidably receiving a planar shape defining the acoustic reflector.
 20. The device of claim 12 wherein the surgical region and surgical target are based on a kidney location in a human anatomy. 